Department of Mental Health

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Department of Mental Health
Commonwealth of Massachusetts

• Elizabeth Childs, MD
• Commissioner

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Our Vision

• Mental health is an essential part of health
  care. The Massachusetts Department of Mental
  Health, as the State Mental Health Authority,
  promotes mental health through early
  intervention, treatment, education, policy and
  regulation so that all residents of the
  Commonwealth may live full and productive lives.

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Mission Statement

• The Department of Mental Health, as the State
  Mental Health Authority, assures and provides
  access to services and supports to meet the
  mental health needs of individuals of all ages,
  enabling them to live, work and participate in
  their communities. The Department establishes
  standards to ensure effective and culturally
  competent care to promote recovery. The
  Department sets policy, promotes
  self-determination, protects human rights and
  supports mental health training and research.
  This critical mission is accomplished by working
  in partnership with other state agencies,
  individuals, families, providers and communities.

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Principles

• Excellence Pursuing quality, adopting evidence
  based treatment practices and operating in a
  continuous quality improvement framework to
  produce accountable outcomes
• Innovation/Creativity Adopting promising
  treatment practices that promote recovery and
  implementing best of breed administrative
  practices to support system operations
• Efficiency Ensuring cost effective, local
  services and supports that maximize outcomes.
• Value Promoting effective care that has high
  value to consumers, citizens and our communities.
  Value is the product of excellence, efficiency
  and innovation.

Ensure high value treatment and supports to
people with mental illnesses to empower personal
growth and to promote an optimal and productive
life in the community.
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National Context New Freedom Commission

• In a Transformed Mental Health System
• Americans understand that mental health is
  essential to overall health
• Mental health care is consumer and family driven
  and recovery oriented
• Disparities in mental health services are
  eliminated
• Early mental health screening, assessment, and
  referral to services are common practice
• Excellent mental health care is delivered and
  research is accelerated
• Technology is used to access mental health care
  and information
• Citation Presidents New Freedom Commission

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New Change New GovernanceEOHHS Reorganization

• Leadership defined the focus of reorganization
  around coordinating services and programs while
  streamlining core administrative processes.
• EOHHS agencies A common health and human
  services enterprise.
• Three new offices established Children, Youth
  and Families Health Services Disabilities and
  Community Services. DMH is part of the Health
  Services cluster along with the Department of
  Public Health.
• Mental Health emerged as a critical lynchpin
  service provider that cuts across all EOHHS
  offices in a fundamental way.

April 1- June 30
Through April 30

• Incorporate Broader DMH and MHBH Staff
  Participation into Plan Specifications and
  Implementation Strategies

• Leadership and Senior Management Develop
  Strategic Framework

• Phase III Incorporate Other Agencies,
  Consumers, Advocates and Community Leaders

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DMH Mandate

• MGL, Chapter 19, Section 1
• The Department shall take cognizance of all
  matters affecting the mental health of the
  citizens of the Commonwealth.

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DMH Overarching Principles

• 1. All services are consumer-centered and
  family-driven.
• 2. Resiliency and recovery are the ultimate goals
  for all services and supports.
• 3. Quality improvement principles must be
  embedded in everything we do.
• 4. Services should be local.
• 5. We must add value to our local communities.
• 6. Effective behavioral health services are
  critical to the success of many other state
  agencies and we must actively partner with these
  organizations to achieve our common mission.

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What We Do

• The Secretary of Health and Human Services has
  charged the DMH Commissioner with responsibility
  for coordinating mental health service issues
  across the EOHHS agencies, with particular
  attention to children and adolescents, and the
  homeless. Focusing on community care services,
  DMH
• provides supportive clinical and rehabilitative
  services for adults with serious mental illness
  and children and adolescents with serious mental
  illness or serious emotional disturbance
• integrates public and private resources for
  optimal community-based care opportunities
• has oversight of the Behavioral Medicaid
  programs, including acute inpatient psychiatric
  services, emergency services, and other
  behavioral medicine services and programs

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What We Do
The Department of Mental Health provides an array
of services from adult extended stay inpatient
services and latency age and adolescent inpatient
and intensive residential treatment facilities to
a community-based services continuum.
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Key Statistics

• DMH directly serves 26,000 individuals, including
  about 3,500 children and adolescents.
• With the integration of DMH and MassHealth
  Behavioral Health Programs, DMH has programmatic
  supervision of behavioral health services for
  900,000 residents of the Commonwealth.
• Of the adult DMH clients, 78 percent receive
  Medicaid, 24 percent receive Medicare and 12
  percent are uninsured.

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Key Statistics

• DMH operates 3 psychiatric hospitals, 8 community
  mental health centers, one contracted unit, and
  psychiatric units in two DPH operated hospitals
  with a total inpatient capacity of 996 adult beds
  and 48 adolescent continuing care beds.
• In FY2004, approximately 14,700 individuals,
  including children and adolescents, received
  statutory evaluations and/or other forensic
  services from DMH through the adult and juvenile
  court system.
• In FY2004, the DMH Forensic Transition Team
  planned the release and monitored the transition
  of 503 inmates with serious mental illness from
  incarceration to community mental health
  services.
• Since the early 1990s, DMH, working alone or with
  a formal partner or agent, has developed housing
  opportunities for more than 5,600 of our clients
  who previously lived in substandard housing or
  were homeless.

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Initiative 1Unified Behavioral Health System

• The Commonwealth is realizing the vision of a
  unified public behavioral health system since the
  Department of Mental Health and its Commissioner
  has been delegated oversight by the EOHHS
  Secretary of the MassHealth Behavioral Health
  Unit and its function.
• Goals
• Improve access to and quality of services
• Standardize criteria for service entry,
  continuing care and discharge
• Evidence based services
• Ensure high quality clinical decision making
• Provide least restrictive settings to facilitate
  resiliency and recovery

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Unified Behavioral Health System
When fully implemented, the Unified Behavioral
Health System will
DMH has articulated five high-level goals for the
Unified Behavioral Health System. Together,
these address the challenge of delivering
adequate, efficient, and coordinated care.

• Deliver person and family-centered care and
  treatment that is evidence-based,
  recovery-oriented, and culturally competent
• Support equitable access to the right treatment
  at the right time through coordination of
  benefits, administration and services across
  organizational entities and funding streams
• Provide a forum where health and human service
  agencies will collaborate to improve access to
  services for special needs populations and for
  persons with conditions that are co-occurring
  with behavioral disorders
• Promote a flow of information and knowledge as
  the foundation for data supported decision making
  on standards of care, allocation of resources,
  and performance outcomes
• Produce results that are efficient, economical,
  and accountable to the citizens who use publicly
  funded behavioral health services and to the
  taxpayers who support the system

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Unified Behavioral Health System

• The Unified Behavioral Health System will
  coordinate services and administration across the
  DMH and MassHealth systems of care through
  different mechanisms
• System Re-Design / Re-Procurement
• Regulatory Change or Waivers
• Contractual Influence

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Unified Behavioral Health System
Successful design and implementation of the
Unified Behavioral Health System require active
participation from multiple entities.

• Active collaboration with MassHealth
• The Steering Group charged with designing the
  Unified Behavioral Health System will include
  members from the Office of Medicaid, Office f
  Acute and Ambulatory Care, and other areas of
  MassHealth.
• MHBH program staff are now physically located at
  DMH and are an integral part of the core Unified
  System Steering Group
• MHBH and DMH staff currently collaborate both on
  longer-term system design plans and on current
  management activities
• Participation from other EOHHS Agencies
• The Steering Group has established several
  statewide work groups (Service Planning and
  Design, Current State Analysis, Administrative
  and Financial Strategy) that will include
  participation from other state agencies
• The Steering Group and statewide work groups will
  pursue an inter-agency approach as they explores
  best practices and system needs, particularly as
  they relate to children and to people with
  disabilities
• Active public dialogue from stakeholders
• The Steering Committee will release frequent
  Requests for Information (RFI) and will hold
  public meetings and focus groups with consumers,
  providers, advocates and other stakeholders

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Initiative 2 Community Expansion, Inpatient
Consolidation and a New Hospital

• The Departments Inpatient Study Report of March
  2004 outlines three basic issues The limitations
  posed by two antiquated facilities advanced
  standards of care and treatment of individuals
  with mental illness that have far outpaced our
  existing infrastructure and the need to expand
  the DMH community service system in order to
  sustain client tenure in community placements.
• The Facility Feasibility Commission, established
  by section 364 of Chapter 149 of the Acts of
  2004, is assessing the feasibility of building a
  state-of-the-art DMH psychiatric hospital in
  Central Massachusetts. The foundation of the
  Commissions work is the imperative to provide
  community placements for those individuals in
  state hospitals who are entitled to live in less
  restrictive settings.

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Community Expansion, Inpatient Consolidation and
a New Hospital

• A major feature of the plan is a reduction of
  DMHs statewide adult continuing care bed
  capacity from 900 to 740, including a reduction
  of the combined bed capacity of Worcester and
  Westborough State Hospitals from 354 beds to 260
  and the consolidation of that capacity in a new
  state-of-the-art inpatient psychiatric facility.
• The Department enjoys a history of success in
  this arena. DMH closed Medfield State Hospital in
  2003 and used the resulting savings to
  successfully place 255 clients from across the
  state in community settings, including 59 former
  patients from Medfield.
• Develop new community placements to serve 268
  current DMH hospital residents
• Completed 104 individuals placed into the
  community as of 03/09/05
• Planned 164 continuing care patients placed by
  12/31/05

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Initiative 3Comprehensive Quality Improvement
Plan

• Goal
• Develop a customer-informed, data-driven
  infrastructure to continuously improve behavioral
  health services in the Commonwealth
• Strategies
• Use reliable, transparent and accessible data
• Quality will be defined by the needs of
  individuals, families and communities
• Commitment to evidence-based practices and the
  sharing of best practices
• Commitment to innovation and creativity

Quality
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Comprehensive Quality Improvement Plan
The meaning of the word quality is changing
There is momentum in the field to incorporate
clinical outcomes with a broader emphasis on
service excellence, increasing value and reducing
waste.
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Restraint and Seclusion ReductionA CQI
Initiative

• DMH is committed to eliminating the use of
  restraint or seclusion in its facilities and
  programs. This goal is consistent with a mental
  health system that treats people with dignity,
  respect and mutuality, protects their rights,
  provides the best care possible, and assists them
  in their recovery.
• A recent grant award will support DMH efforts to
  coordinate a statewide R/S reduction, bolster
  current efforts, accelerating an already
  aggressive program.
• Evaluate the process and outcomes and consumer
  roles in a three-year project.
• Project will significantly improve mental health
  services in the 11 DMH facilities and, by
  example, help to improve mental health services
  across Massachusetts.

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Suicide Prevention A CQI Initiative

• DMH collaborates with the Department of Public
  Health, and is active in statewide suicide
  prevention efforts through the Massachusetts
  Coalition for Suicide Prevention and the
  Statewide Strategic Plan for Suicide Prevention.
  Three priority goals of this effort are
• Build broad support for suicide prevention
• Reduce stigma associated with mental illness
• Trainings to recognize suicidal behavior and
  risks
• DMH Commissioner Elizabeth Childs, M.D.,
  co-chaired the EOHHS Suicide Prevention Task
  Force
• DMH co-sponsors the annual statewide Suicide
  Prevention Conference in May

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Our Anti-Stigma Work

• The Presidents New Freedom Commission
  identifies stigma as the main barrier to
  treatment. Mental illness is a public health
  problem that requires a public health approach.
  Historically, the Department of Mental Health has
  been in the forefront of efforts to increase
  awareness about mental illness and educate the
  public that mental illnesses, like cancer and
  diabetes, are treatable and that people can
  recover and live productively in their
  communities.
• In 1997, DMH, along with its advocacy partner,
  the Massachusetts Association for Mental Health
  (MAMH), launched the Changing Minds Campaign ? a
  pioneering effort in Massachusetts to remove the
  stigma of mental illness, the major barrier to
  treatment. Our latest anti-stigma work involves
  a federal mental illness awareness project called
  the Elimination of Barriers Initiative (EBI) and
  a SAMHSA National Anti-Stigma Campaign.